Coronavirus Insurance


Coronavirus Insurance

The COVID-19 pandemic has brought into focus the need for health insurance coverage. As hospital bills run into lakhs of rupees, and families of COVID patients find themselves in desperate situations at the time of hospital admission, insurance companies have been supporting and playing a major role in easing the financial burden.

Four months into the pandemic, health insurance and general insurance companies in India are bringing in specific policies to cover hospitalization and treatment charges.

COVID-19 has brought a paradigm shift in people's mindset. Coronavirus has led to an increased awareness amongst people about the importance and benefits of health insurance during a pandemic situation like COVID-19.

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COVID-19 Impact on 2020 Claims Experience

India's health insurance sector is feeling the financial brunt of the coronavirus pandemic, with claim reported numbers increasing consistently.

Covid-19 infection is a new illness with no established protocols and standardised treatment costs. In the absence of any standardised rates for Covid-19 treatment, it has been seen that hospitals, in some cases, were charging a lot for Covid-19 treatment, forcing insurance companies to question the claims.

The average claim cost across all states is ranging between Rs 85000 – Rs 90000, and the average claim cost in metro locations is far higher.

Health Insurance options available

  • All ‘Indemnity based health insurance products” that cover the treatment costs of hospitalization offered by all general and health insurance companies cover the costs of hospitalization treatment on account of COVID-19.
  • Recently the insurance regulator of India, IRDAI mandated insurance companies to offer two different ‘need-based’ short term policies to cover hospitalization expenses with respect to the treatment of COVID-19.
    • Corona Kavach - Indemnity based
    • Corona Rakshak - Benefits based
    Both the covers are short term policies with a tenure of 9.5 months, 6.5 months or 3.5 months. From the beginning of August 2020, some of the insurance companies have started offering the group variant of the Corona Kavach policy as well. For example, Corona Kavach Group Policy by Raheja QBE General Insurance.
  • Apart from these, some of the insurance companies are coming up with more innovative covers suitable for groups. For example, Covid – 19 Group Policy by Chola MS General Insurance (Benefit based), Covid – 19 Group Policy by Reliance General Insurance (Indemnity based) and Digit Illness Group Insurance by Digit Insurance.

These policies have been designed largely to widen the coverage of health insurance in India. There is an increased awareness amongst the common man. There are some attractive features of these policies worth considering like,

  • the short tenure options,
  • reduction in waiting period,
  • inclusion of certain co-morbidities along with pre-existing diseases,
  • home health care benefit (Corona Kavach),
  • no room rent sub-limit

Corona Kavach

It is an indemnity-based health insurance cover which is offered as an individual as well as a family floater policy.

Range of Sum Insured: Rs 50000 to Rs 500000 (In multiples of Rs 50000)

Corona Kavach policy can be taken for self, spouse, dependent children, parents and parent-in-laws.

The cover eligibility extends from day 1 of birth till 65 years of age.

This policy covers hospitalization cost that includes room / ICU rent, Doctors’ fee, anaesthesia, blood, oxygen charges, medicines, diagnostic costs etc. A minimum period of 24 consecutive hours of hospitalization is required.

A Corona Kavach policy typically covers a pre-hospitalization of 15 days prior to the hospitalization or home care treatment and a post hospitalization of 30 days after the discharge or completion of the home care treatment.

Ayush treatment covered.

Ambulance cover offered with a maximum limit of Rs 2000 / hospitalization

Some highlights of Corona Kavach Health Insurance Policy are:

  • No room rent sub-limit
  • No co-payment
  • No zone-based pricing
  • No pre-policy check-up required
  • These will cover pre-existing illnesses (comorbidities) along with the treatment of Corona Virus (after an underwriting assessment is done). Other health insurance policies usually cover some Pre-Existing Diseases after a WP of 2 to 4 years
  • 15 days waiting period
  • Children covered from day 1 of their birth
  • Home care expenses covered – Up to 14 days per incident. It is covered only in case there is a positive diagnosis of Covid from a Government authorised diagnostic centre. Most importantly, the home care is advised by a Medical Practitioner along with an active line of treatment with monitoring of the health status every day. For the claim, a daily monitoring chart including records of treatment by the treating doctor is required.
  • Coverage for essential consumable - PPE kit, Gloves, Masks etc (these may not otherwise be covered under any other standard health insurance)

Hospital Daily Cash: Corona Kavach Policy gives an option of an add on cover of Hospital Daily Cash (this optional cover is benefit based). As per the guidelines the insured person will get 0.5% of the sum insured per day for up to a maximum of 15 days during hospitalization.

Many insurers offer a range of discounts under Corona Kavach Policy:

  • Discount for health care workers
  • Family discount - Non floater
  • Family Floater discount
  • Female insured discount
  • Loyalty discount
  • Employee discount

Who should buy a Corona Kavach Policy?

  • People who do not have a Health Insurance Policy for their family and themselves
  • People who have a Health Insurance Policy of a lower Sum Insured or with a Room Rent sub-limit (Sub-limits result in a proportionate deduction whereas Corona Kavach Policy doesn’t have a limit on room rent / ICU). Corona Kavach Policy can be bought as a supplementary cover.

Corona Rakshak

It is a benefit based Health Insurance Policy where Lump sum benefit equal to 100% of the Sum Insured would be payable on positive diagnosis of COVID. This is offered as an Individual policy only.

Range of Sum Insured: Rs 50000 to Rs 250000 (In multiples of Rs 50000)

Corona Rakshak policy can be taken for self, spouse, dependent children, parents and parent-in-laws.

The minimum requirement is a hospitalization for a continuous period of 72 hours.

The positive diagnosis of COVID should be from a government authorized diagnostic centre.

The cover eligibility starts from 18 years to 65 years of age.

There is 15 days waiting period from the start of the policy, to avail the benefits.

The policy will terminate when 100% of the Sum Insured is paid.

Who should buy a Corona Rakshak Policy?

People who already have a Health Insurance Policy. But a hospitalization may impact the financial position of the person. In such a case, Corona Rakshak Policy acts as a replacement of his/her income.

What is not covered in both Corona Kavach and Corona Rakshak Policies

  • Non – authorised diagnostic centres: A claim can be rejected if the Covid test is carried out in a non-authorised diagnostic centre. The test has to be carried out from a Government authorised diagnostic centre.
  • Home quarantine cases without an active line of treatment for Corona Kavach Policy. Home quarantine is not covered under Corona Rakshak Plan.
  • Claim within waiting period: There is a stipulated 15 days waiting period within which no claim is entertained.

Plan Comparison: Corona Kavach Vs Corona Rakshak

  Corona Kavach Corona Rakshak
Base Policy Indemnity Basis Benefits Basis
Tenure 3.5 Months, 6.5 Months, 9.5 Months 3.5 Months, 6.5 Months, 9.5 Months
Range of SI Rs 50000 to Rs 500000 (in multiples of Rs 50000) Rs 50000 to Rs 250000 (in multiples of Rs 50000)
Coverage
  • Hospitalization Expenses. Hospitalization for a minimum continuous period of 24 hours
  • Home Care Treatment expenses
  • AYUSH Treatment
  • Pre- Hospitalization - 15 days
  • Post - Hospitalization - 30 days
  • Cost of treatment of any Co-morbid condition (including Pre-existing Comorbid condition, if any)
  • Lump sum benefit equal to 100% of the Sum Insured shall be payable on positive diagnosis of COVID
  • Hospitalization for a minimum continuous period of 72 hours
  • The positive diagnosis of COVID shall be from a government authorized diagnostic centre.
Optional Cover Hospital Daily Cash
Type of Policy Individual or Family Floater Individual
Entry Age 18 years 18 years
Max Age 65 years 65 years
Dependent Children 1 Day to 25 years
Waiting Period Initial Waiting period of 15 Days Initial Waiting period of 15 Days

Frequently Asked Questions

  • Is there a waiting period for Corona Kavach?
    Yes. There is a waiting period of 15 days from the commencement date of the policy. After this period only a claim can be made.
  • Is Ayush treatment covered under the Corona Kavach Policy?
    Yes. Ayush treatment is covered (without a sub limit) upto the chosen Sum Insured.
  • What is Home Care Treatment in Corona Kavach Policy?
    The Insurance companies will cover the cost of a treatment incurred by the insured person for availing treatment at home for up to 14 days per incident. This cover is only extended in case there is a positive diagnosis of Covid 19 from a Government authorised diagnostic centre. Most importantly, the home care is advised by a Medical Practitioner along with an active line of treatment with monitoring of the health status every day. For the claim, a daily monitoring chart including records of treatment by the treating doctor is required.
  • Does Corona Kavach cover pre-existing diseases?
    Under Corona Kavach Plan any co-morbid condition (including pre-existing comorbidities) will be covered along with the treatment of Covid – 19 up to the Sum Insured. Some of the insurance companies have given a list of pre-existing conditions or diseases that are not covered.
  • How is Corona Kavach Plan different from Corona Rakshak Plan?
    Corona Kavach is an indemnity based short-term health insurance policy specifically for Coronavirus treatment. It covers the cost of hospitalization, pre-hospitalization, post hospitalization, treatment of co-morbidities and home care treatment.

    Corona Rakshak is a short term benefits based plan where a lumpsum 100% payout is made to the insured person on a positive diagnosis of Covid – 19 followed by a 72 hours continuous hospitalization.
  • Is cashless or reimbursement facility supported by Corona Kavach Plan?
    Both cashless and reimbursement facilities are available. Cashless facility can be availed if the treatment is taken in a network hospital.

Some of the Covid-19 Group Policies available in the market

1) Covid – 19 Group Policy by Chola MS General Insurance (Benefit based)

  • Chola MS Covid -19 policy is an insurance cover intended to provide a lump sum benefit if the insured is diagnosed with the Covid infection during the policy period.
  • This insurance is available to persons aged between 3 months and 65 years (completed age) at the time of commencement date of this policy.
  • The proposer should be 18 years on the commencement date of this policy.
  • Insured can avail the cover for self, spouse, parents and dependent children upto 2
  • Sum Insured applicable : Rs 10000, Rs 20000, Rs 30000, Rs 40000, Rs 50000
  • Minimum lives required to be covered is 500
  • Policy period is 1 Year
  • Waiting Period - Initial 16 days of the commencement of the policy
  • Claims Process: Within 30 days of the discharge from hospital/treatment/occurrence of the event the Policyholder or the Primary Insured shall provide the with details of the claim to be paid as per the claim
  • Payment will be made to the insured person
  • Claim documents required:
    • Duly filled & signed claim form along with Govt. issued ID proof.
    • Detailed discharge/Death summary specifying the disease & treatment details.
    • COVID - 19 confirmatory lab report (Real time PCR assay for RNA virus) from Govt. or authorized centre as declared by Govt. of India.
    • Policy Number and Certificate number mentioned in the excel shared

2) Covid – 19 Group Policy by Reliance General Insurance (Indemnity based)

  • This is a Non-floater policy – Only for self (Individual), maximum age is 60 years.
  • Hospitalisation Cover Medical Expenses incurred on Hospitalisation due to Diagnosis of presence of COVID-19.
  • Waiting Period: 15 days from the policy start date
  • Pre-Hospitalisation Covers the Medical Expenses incurred upto 30 days prior to date of Hospitalisation.
  • Post -Hospitalisation Covers the Medical Expenses incurred upto 60 days post discharge from the Hospital
  • The Sum Insured options are Rs 50000, Rs 100000, Rs 150000, Rs 200000, Rs 250000, Rs 300000, Rs 350000, Rs 400000, Rs 450000, Rs 500000.
  • Covers the Medical Expenses during Quarantine, starting from the 4th day of Quarantine for a maximum of 15 days during the Policy Period Up to 50% of Sum Insured
  • Any one of Hospitalisation Cover or Quarantine Cover will be payable at a time.
  • Road ambulance cover is covered up to Rs 3000.
  • Specific Exclusion:
    • Co-habitation: No claim is payable where the Insured Person was living with and sharing the same address as that of person(s) who were Diagnosed with COVID-19 or Quarantined at the time of Proposal.
    • Unauthorized Testing canter: Testing done at a Diagnostic center other than the ones authorized by the Union Health Ministry of India will not be recognised under this Policy
    • Out of India: Diagnosis and/or Treatment taken outside India is not covered
    • Self-Quarantine: Self-Quarantine is not covered
    • The Insured Person should not have travelled against the travel advisory, whether in-force or freshly issued by Government of India at any time during the Policy Period.
    • Any expenses incurred on Domiciliary Hospitalisation and OPD treatment.

3) Digit Illness Group Insurance by Digit Insurance

  • This is an indemnity cover with the Sum Insured chosen for each individual to be covered, maximum age 60 years.
  • Room Rent / ICU Restriction: No
  • Pre-Hospitalisation Covers the Medical Expenses incurred upto 30 days prior to date of Hospitalisation.
  • Post -Hospitalisation Covers the Medical Expenses incurred upto 60 days post discharge from the Hospital
  • Road ambulance cover has a limit of 1% of the Sum Insured (up to Rs 5000)
  • A second medical opinion is covered.
  • The Sum Insured options are Rs 50000, Rs 100000, Rs 150000, Rs 200000, Rs 250000, Rs 300000
  • This can be availed for self, spouse and 2 dependent children
  • Waiting period: 15 days from the policy start date. It can be waived off for a group size of more than 50 members.
  • Pre Existing Disease Waiting Period – 4 years. (specifically related to Covid-19)
  • Coverage is applicable only if the insured member(s) is/are diagnosed with and hospitalised solely for COVID-19.
  • Specific Exclusion:
    • Insured members already treated for or quarantined for Coronavirus disease (COVID-19) before the policy issuance will not be covered.
    • Treatment taken outside India will not be covered
    • Home hospitalisation (Domiciliary hospitalisation) expenses will not be covered
    • In case of a claim for COVID-19 infection with any co-morbid condition, claim will become eligible however the expenses related to co-morbid condition will be deducted. (eg., if the person is Diabetic, all blood sugar testing, Insulin or anti diabetic medications will be disallowed). However the overall other expenses incurred for the treatment of COVID is payable
  • Claim documents required:
    • COVID-19 Positive test report from ICMR authorized labs.
    • Consultation Papers
    • Hospital Details
    • Discharge summary
    • All other test reports
    • Valid ID proof (PAN, Voter ID, DL, Passport)
    • All Original bills (Final bill, break up, Pharmacy and test bills, etc.)
    • Employee ID number (If applicable)

Plan Comparison: Covid – 19 Group Policy by Chola MS General Insurance VS Covid – 19 Group Policy by Reliance General Insurance VS Digit Illness Group Insurance by Digit Insurance

  Chola MS General Insurance Covid - 19 Policy Cover Reliance General Covid - 19 Policy Cover Digit Illness Group Insurance
Base Policy Benefits Basis Indemnity Basis Indemnity Basis
Tenure 1 Year 1 Year 1 Year
Waiting Period Initial Waiting period of 16 Days Initial Waiting period of 15 Days Initial Waiting period of 15 Days (This can be waived off for a group size more than 50 members)
Range of SI Rs 10000, Rs 20000, Rs 30000, Rs 40000, Rs 50000 Rs 10000, Rs 20000, Rs 30000, Rs 40000, Rs 50000 Rs 50000 to Rs 300000 (in multiples of Rs 50000)
Coverage
  • Lump sum benefit equal to 100% of the Sum Insured shall be payable on positive diagnosis of COVID
  • Payment will be made to the insured person
  • Hospitalisation Cover Medical Expenses incurred on Hospitalisation due to Diagnosis of presence of COVID-19
  • Covers the Medical Expenses during Quarantine, starting from the 4th day of Quarantine for a maximum of 15 days during the Policy Period Upto 50% of Sum Insured
  • Pre- Hospitalization (30 Days)
  • Post - Hospitalization (60 Days)
  • Coverage is applicable only if the insured member(s) is/are diagnosed with and hospitalised solely for COVID-19.
  • Positive test report for Coronavirus disease (COVID-19) conducted from Govt/ICMR Authorized test Centre in India
  • Hospitalisation expenses due to Quarantine for COVID-19 are also covered if the insured member(s) was/were suffering from COVID -19 during the hospitalisation and the said hospitalisation was solely due to COVID-19.
  • Insured member(s) should not suffer from any respiratory related symptoms like severe cough, respiratory distress,breathlessness continuously from last 2 weeks at the time of buying this policy
  • Pre- Hospitalization (30 Days)
  • Post - Hospitalization (60 Days)
Road Ambulance Covered up to Rs 3500 per incident 1% of the SI (up to Rs 5,000)
Optional Cover Waiver of Initial waiting period and Co-morbidity clause (min 50 employees)
Type of Policy Group (Individual) Individual (Only for employees)
Family not covered
Individual
Who can be covered Self (Employee), First two living Children, Spouse, Parents Self (Employee) Self, Spouse, Two dependent Children
Entry Age 18 years 18 years 18 years
Max Age 65 years 60 years 60 years
Dependent Children 3 months to 25 Years (Dependent Children Can’t Be Covered Beyond The Age Of 25 years) 1 Day to 25 years
Discount For Large groups
SI Rs 5K-1L: 2.5%
1L-2L: 5%
>2L: 7.5%
Minimum Lives Required to be covered 500 25 50

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